Introduction to Medical Law and Ethics

[Pages:46]Introduction to Medical Law and Ethics

Dr. Gary Mumaugh

Objectives

? Explain why knowledge of law and ethics is important to health care providers ? Recognize the importance of a professional code of ethics ? Distinguish among law, ethics, bioethics, etiquette, and protocol ? Define moral values and explain how they relate to law, ethics and etiquette ? In a general sense, state the consequences of illegal and unethical behavior ? List some bioethical concerns to health care providers

Why even study law and ethics?

? To help you function at the highest possible level of professionalism ? To help you avoid legal problems that would threaten your ability to function and

succeed o We live in a litigious society, and in order to function in healthcare we all must C.Y.A. o We are all at risk of litigious involvement

Knowledge of law and ethics helps us gain perspectives in the following areas:

? The rights, responsibilities and concerns of healthcare consumers ? The legal and ethical issues facing society, patients and health care providers are

constantly changing

? The impact of rising costs on the laws and ethics of health care delivery

Court Cases Illustrate Risk of Litigation

? Plaintiff ? the person bringing the suit ? Defendant ? person against whom the suit is brought ? Liable ? legally responsible ? Precedent ? a case that serves as a model for future cases ? Summary judgment ? a decision made by the court in a lawsuit in response to a

motion that pleads there is no basis for a trial

? Fraud ? dishonest or deceitful practices in depriving, or attempting to deprive,

another of his or her rights

Court Cases

? Patient sues hospital

o Lichti v. Schumpert Medical Center (LA Court of Appeals, 1-26-00)

? County liable in ambulance delay

Koher v. Dial, 653 N.E. 2d 524 (IN Court of Appeals, 6-26-95)

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Law

? A defined rule of conduct or action prescribed or formally recognized as binding or

enforced by a controlling authority

? Governments enact laws to keep society running and to control behavior that could

threaten public safety

? Laws are considered the minimum standard necessary to keep society functioning ? Many laws affect health care providers, including criminal and civil statutes as well

as medical practice acts

Ethics

? Are concerned with standards of behavior ? The concept of right and wrong ? Over and above what is legal in any given situation ? An illegal act by a healthcare provider is always unethical, but an unethical act is not

necessarily illegal

? Code of ethics

o A system of principles intended to govern the behavior of those entrusted with providing care to the sick

Moral Values

? One's personal concept of right and wrong ? Formed through the influence of family, culture and society ? Serves as the basis for ethical conduct ? Acting morally towards others requires that we put ourselves "in their shoes"

Definitions of Law, Ethics and Morals

? Law - set of governing rules ? Ethics ? principles, standards, guide to conduct ? Moral Values ? beliefs formed through the influence of family, culture and society

Main Purpose of Law, Ethics and Morals

? Law - protects the public ? Ethics ? to elevate the standard of competence ? Moral Values ? To serves as a guide for personal ethical conduct

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Standards of Law, Ethics and Morals

? Law - minimal to promote smooth society functioning ? Ethics ? builds values and ideals ? Moral values ? serves as a basis for forming a personal code of ethics

Penalties for Violation of Law, Ethics and Morals

? Law ? civil or criminal liability

o Fines, imprisonment, penalties, revocation of license

? Ethics ? suspension from or eviction from medical society membership ? Moral Values ? difficulty in getting along with others

Definitions of Bioethics, Etiquette and Protocols

? Bioethics ? discipline relating to ethics concerning biological and healthcare

research

? Etiquette ? courtesy and manners ? Protocols ? rules of etiquette applicable to one's place of employment

Main Purpose of Bioethics, Etiquette and Protocols

? Bioethics ? to allow scientific progress in a manner that benefits society in all

possible ways

? Etiquette ? to get along with others ? Protocols ? to get along with others engaged in the same profession

Standards of Bioethics, Etiquette and Protocols

? Bioethics ? leads to the highest standards possible in applying research to medical

care

? Etiquette ? leads to pleasant interaction ? Protocols ? promotes smooth functioning of workplace routines

Penalties for Violation of Bioethics, Etiquette and Protocols

? Bioethics ? penalties can include all those of law and ethics ? Etiquette ? ostracism from chosen groups ? Protocols ? disapproval of professional colleagues and possible loss of business

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Examples of Bioethical Considerations

? Is human experimentation essential, or even permissible, to advance biomedical

research?

? What ethics should guide organ transplants? ? Should certain people have lower priority on the transplant list? ? What ethics should guide fetal tissue research? ? Do reproductive technologies offer hope to the childless, or are they unethical? ? Should animals ever be used in research? ? How ethical is genetic research? ? Others?

The Role of Ethics Committees

? Most healthcare providers are able to resolve a majority of the issues they face in

the workplace from their own intuitive sense of moral values and ethics.

? Some ethical dilemmas are not so much a question of right and wrong, but more a

question of "which of these alternatives will do the most good and the least harm?"

? In these ambiguous situations, healthcare providers may ask the advice of a medical

ethicist or members of institutional ethics committees.

Medical ethicists or bioethicists

? Specialists who consult with physicians, researchers, and others to help them make

difficult decisions

Ethics committees

? Made up of individuals involved in a patient's care ? Includes physicians, nurses, social workers, clergy, members of the patient's family,

community members, and other providers

? Committees decisions are not binding, but they do help to resolve situations ? They may also be involved in conflict resolution ? They do not function as institutional review boards or morals police looking for health

care workers who have committed unethical acts

Qualities of Successful Health Care Providers

? Three C's of successful practitioners

o Courtesy o Compassion o Common sense

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Qualities of Successful Health Care Providers

? Three T's of great patient care

o Talk o Touch o Time

People Skills Needed in Healthcare

? Present time consciousness ? Relaxed attitude when meeting new patients ? Good communication skills ? Patience ? Tact ? Ability to impart information clearly and accurately ? Ability to keep information confidential ? Ability to leave home at home

o "Flashlight always on the patient"

? Trustworthiness ? Sense of responsibility

Technical Skills Needed in Healthcare

? Computer literacy ? Proficiency in language, science and math ? Willingness to learn new skills and techniques ? Must be a lifetime learner ? Aptitude to work hands on ? Ability to document well

Ethics Guidelines - Allocation of Medical Resources

? The benefit of the patient must always be placed above policies allocating limited

medical resources

? Decisions should consider only

o Likelihood of benefit o Urgency of need o Change in quality of life o Duration of benefit

? Nonmedical criteria that should never be used to make allocation of resources

o Ability to pay, age, social standing, perceived treatment obstacles, patient's contribution to their illness, past use of resources

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Ethics Guidelines - Futile Care

? Healthcare providers CAN NOT deliver care, that in their professional judgment, will

not provide benefit to their patients

? Patients should not be treated simply because they demand treatment ? Denial of treatment should be based on ethical principles and standards of care

Ethics Guidelines - Costs

? Healthcare providers should be conscious of costs and should not prescribe

unnecessary services Ethics Guidelines - Unnecessary Services

? Healthcare providers should never provide, prescribe, or seek payment for medical

services they know are unnecessary

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Working in Healthcare

Dr. Gary Mumaugh

Objectives Define licensure, certification, registration and accreditation Explain the purpose of the medical practice act Explain the purpose of medical practice boards Learn licensure for your profession Cite reasons a physician can lose a license Discuss the doctrine of respondeat superior Discuss two federal acts that prohibit fraud and abuse in health care billing Define three types of managed care plans Define telemedicine, cybermedicine, and e-health, and discuss their roles in today's

health care environment

Key Terms Licensure

o A mandatory credentialing required by law, usually at the state level, that grants the right to practice certain skills and endeavor

Certification o A voluntary credentialing process whereby applicants who meet specific requirements may receive a certificate

Registration o An entry in an official registry or record, listing the names of persons in a specific occupation who have satisfied requirements

Accreditation o Official authorization or approval for conforming to a specified standard

Medical practice acts State laws written for the express purpose of governing the practice of medicine In all 50 states, medical practice acts have been established by statute to govern the

practice of medicine

Medical Boards Boards established by the authority of each state's medical practice acts for the

purpose of the health, safety, and welfare of health care consumers through proper licensing and regulation of physicians and other health care practitioners

Unprofessional Conduct Each state's medical practice acts define unprofessional conduct for medical

professionals Laws vary from state to state. Examples:

o Physical abuse of a patient o Inadequate record keeping o Failure to recognize or act on common symptom

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Unprofessional Conduct o Prescription of treatment in excessive amounts o Failure to meet continuing education requirements o Performance of duties beyond the scope of license o Dishonesty o Conviction of a felony o Delegation of practice to and unlicensed individual

The Physician's Education Four year degree ? usually a science concentration USMLE ? US Medical Licensing Examinations

o Part 1 ? After first year of medical school o Part 2 ? In fourth year of medical school o Part 3 ? During first two years of residency Residency o First year is called internship o Residency can last two to six years NBME - Diplomat o Certifies after passing all three parts and finishing internship ABMS ? American Board of Medical Specialists o Specialty examination after residency for board certification in area of

specialty

Physician's State Licensure After physician's have finished their education and passed all national boards, their

continued licensure falls under the state jurisdiction medical boards Federal government has no medical licensing authority except for the permit issued

by the DEA for physician's to RX controlled substances, narcotics and non-narcotics State criteria for licensure

o Must be 21 year old and of good moral character o Completed four year degree and medical degree o Completed residency o Be a US citizen or have filed a declaration to become

Some states have waived this requirement o Must be a state resident and passed all state examinations for registration

Reciprocity The process by which a professional license obtained in one state may be accepted

as valid in other states by prior agreement without examination o Can be full reciprocity or partial reciprocity o May only need to test out on certain state board sections, such as jurisprudence

Endorsement The process by which a license may be awarded based upon credentials judged to

meet licensing requirements

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